Clinical Practice Guidelines for Managing Frailty in Community-Dwelling Korean Elderly Adults in Primary Care Settings.

Aging has become a global problem, and the interest in healthy aging is growing. Healthy aging involves a focus on the maintenance of the function and well-being of elderly adults, rather than a specific disease. Thus, the management of frailty, which is an accumulated decline in function, is important for healthy aging. The adaptation method was used to develop clinical practice guidelines on frailty management that are applicable in primary care settings. The guidelines were developed in three phases: preparation (organization of committees and establishment of the scope of development), literature screening and evaluation (selection of the clinical practice guidelines to be adapted and evaluation of the guidelines using the Korean Appraisal of Guidelines for Research and Evaluation II tool), and confirmation of recommendations (three rounds of Delphi consensus and internal and external reviews). A total of 16 recommendations (five recommendations for diagnosis and assessment, 11 recommendations for intervention of frailty) were made through the guideline development process. These clinical practice guidelines provide overall guidance on the identification, evaluation, intervention, and monitoring of frailty, making them applicable in primary care settings. As aging and "healthy aging" become more and more important, these guidelines are also expected to increase in clinical usefulness.

Determinants of family satisfaction with inpatient palliative care in Korea.

OBJECTIVE: We aimed to identify which structures and processes of care are key determinants of overall satisfaction with palliative care. METHODS: A nationwide, multicentre, cross-sectional questionnaire survey was conducted with 501 bereaved family members of terminal cancer patients (effective response rate: 20.9 percent). Structures and processes were evaluated using the Care Evaluation Scale (CES). RESULTS: In univariate analyses, all domains of the CES were significantly associated with overall satisfaction with care. In multivariate analyses, the domains of physical care by physician, physical care by nurse, environment, and coordination positively influenced overall satisfaction. After case-mix adjustment, physical care by nurse, age of patient, and lower education level of bereaved family member remained as significant determinants. CONCLUSION: Our finding that nursing is the most critical determinant of overall satisfaction within many structure and process domains has an important implication for clinical quality improvement and resource allocation.

Low bone mineral density is associated with dyslipidemia in South Korean men: the 2008-2010 Korean National Health and Nutrition Examination Survey.

This study examined the relationship between bone mineral density (BMD) and dyslipidemia in South Korean men. Data from 6,300 men who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2010 were analyzed, including serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) after 8 hours of fasting and mean BMD measured at the lumbar spine (LS), total hip (TH), and femoral neck (FN). Dyslipidemia was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III. Other parameters of dyslipidemia were also calculated, such as TG/HDL-C, TC/HDL-C, non-HDL-C (NHDL-C), and LDL-C/HDL-C. Men with dyslipidemia and high levels of TG, TG/HDL-C, TC/HDL-C, NHDL-C, and LDL-C/HDL-C had lower BMD than men without dyslipidemia at the LS, TH, and FN after adjustment for age and body mass index (all p<0.01). On multivariable regression analysis, all odds ratios for high levels of TG, TG/HDL-C, TC/HDL-C, NHDL-C, and LDL-C/HDL-C with an increase in BMD (per standard deviation) were <1 at all 3 sites after adjustment for age and body mass index (model 1). After adjustment for all covariates, only odds ratios for high levels of TG, TG/HDL-C, TC/HDL-C, and NHDL-C were <1 at all 3 sites (model 2), but an increase in BMD was not associated with high LDL-C levels in models 1 and 2. In conclusion, BMD was inversely correlated with parameters of atherogenic dyslipidemia in South Korean men.

Determinants of the burden and positivity of family caregivers of terminally ill cancer patients in Korea.

OBJECTIVE: Caregivers may experience positive or negative feelings about their role. The study investigated the determinants of the burden and positivity of family caregivers of Korean terminal cancer patients. METHODS: A multicenter cross-sectional survey was conducted with 139 family caregivers. Determinants of caregiver's burden and positivity were assessed by the Caregiver Reaction Assessment Scale and by three questions based on a previous study, respectively. Two separate hierarchical multiple regression models were used. RESULTS: Each domain of the caregiver's burden and positivity was explained by different factors, with the total explained variance ranging between 14.4-33.6% and 2.6-18.3%, respectively. Caregivers who were unmarried, less educated, and/or had low incomes were more likely to be negatively affected, while those who shared caregiving responsibilities were less prone to negative consequences. Caregivers who were male, religious practitioners, and who perceived a higher burden of schedule disruptions were more likely to have a positive perception of their role, while those who perceived a lack of family support were less likely. CONCLUSIONS: Our results highlight the importance of sharing the caregiving burden with the other family members. Organizing a family meeting can provide an opportunity for other family members to acknowledge the feelings and reactions of the primary caregivers, and can prompt the sharing of caregiving responsibilities.

Addressing the religious and spiritual needs of dying patients by healthcare staff in Korea: patient perspectives in a multi-religious Asian country.

OBJECTIVE: We investigated how patients' spiritual and religious needs are addressed by healthcare staff in inpatient palliative care centers in Korea, a multi-religious country. METHODS: We performed a cross-sectional, multicenter survey of terminal cancer patients in inpatient palliative care centers. RESULTS: Approximately half (50.5%) of the patients reported that their spiritual and religious needs were addressed by healthcare staff. Patients whose needs were addressed reported better quality of life (QoL), as measured using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire for Palliative Care, than patients whose needs were not addressed (p<0.05), although these groups did not differ when measured using the Comprehensive QoL Scale. Patients with a religious affiliation [adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 0.70-8.05], those who were admitted to a religious palliative care center (aOR, 2.61; 95% CI, 0.86-7.96), and those whose religious affiliation was the same as that of the palliative care center (aOR, 2.42; 95% CI, 0.96-6.07) tended to have their spiritual and religious needs addressed, although not statistically significant. CONCLUSIONS: Although patients whose spiritual and religious needs were addressed by healthcare staff showed significantly better QoL, such needs were not addressed in a significant proportion of patients, especially those who were not religious or were admitted to non-religious palliative care centers. Strategies should be developed to ensure that spiritual care is provided to all patients with terminal cancer, regardless of the religious background of the patient.

Effects of vitamin treatment or supplements with purported antioxidant properties on skin cancer prevention: a meta-analysis of randomized controlled trials.

AIMS: To investigate the effect of vitamin treatment or supplements with purported antioxidant properties on the primary and secondary prevention of skin cancer using a meta-analysis of randomized controlled trials (RCTs). METHODS: We searched PubMed, Embase and the Cochrane Library in June 2009. Among 398 articles searched, 11 articles on 10 RCTs were included in the final analysis. RESULTS: In a fixed-effects meta-analysis of all 10 trials, vitamin treatment or supplements with purported antioxidant properties were found to have no preventive effect on skin cancer [relative risk (RR) = 0.98; 95% confidence interval (CI) = 0.94-1.03]. Similar findings were observed in a subgroup meta-analysis of 10 studies on both primary prevention trials (RR = 0.98; 95% CI = 0.93-1.03) and secondary prevention trials (RR = 0.97; 95% CI = 0.83-1.13). Further, subgroup meta-analyses revealed no preventive effect on cancer by type of antioxidant, type of cancer and the methodological quality of the studies. CONCLUSION: The current meta-analysis of RCTs indicated that there is no clinical evidence to support an overall primary and secondary preventive effect of vitamin treatment or supplements with purported antioxidant properties on skin cancer. The effect of vitamin supplements on skin cancer should not be overemphasized.

Effectiveness of pharmacologic therapy for smoking cessation in adolescent smokers: Meta-analysis of randomized controlled trials.

PURPOSE: The effectiveness of pharmacologic therapy for smoking cessation in adolescent smokers was evaluated. METHODS: In this meta-analysis, the medical literature was searched for randomized controlled trials (RCTs) investigating the effect of pharmacologic therapy for smoking cessation in smokers age 20 years or younger. The overall effect of pharmacologic therapy was based on the longest follow-up data available in each study. The effects of pharmacologic therapy by follow-up period, type of pharmacologic therapy, and type of strategy analysis were also compared among RCTs. Secondary outcome measures were adverse events reported from each study. RESULTS: Six RCTs involving 816 smokers age 12-20 years were included in the final analysis. No significant increase in abstinence rates was detected with pharmacologic therapy (relative risk [RR], 1.38; 95% confidence interval [CI], 0.92-2.07; I(2) = 0.0%) in a fixed-effects meta-analysis. Similarly, no significant increase in abstinence rates was found in subgroup meta-analyses of studies with both short-term (≤ 12 weeks) (RR, 1.23; 95% CI, 0.92-1.65) and mid-term (26 weeks) follow-up periods (RR, 1.60; 95% CI, 0.90-2.82). Although few serious adverse events were reported, there was no evidence directly linking these effects to the pharmacologic therapy used. CONCLUSION: A meta-analysis found that pharmacologic therapy for smoking cessation among adolescent smokers did not have a significant effect on abstinence rates at short-term and mid-term follow-up times of <26 weeks, and the RCTs examined found few adverse events. However, the results may have been affected by the limited number of participants in published trials.

Coffee consumption and risk of prostate cancer: a meta-analysis of epidemiological studies.

OBJECTIVE: To evaluate the association between coffee consumption and the risk of prostate cancer. METHODS: We searched PubMed, EMBASE, and the bibliographies of relevant articles in August 2009. Two evaluators independently reviewed and selected articles based on predetermined selection criteria. RESULTS: Twelve epidemiological studies (eight case-control studies and four cohort studies) were included in the final analysis. In a meta-analysis of all included studies, when compared with the lowest level of coffee consumption, the overall relative risk (RR) of prostate cancer for the highest level of coffee consumption was 1.16 (95% confidence interval [CI] 1.01-1.33). In subgroup meta-analyses by study design, there was a significant positive (harmful) association between coffee consumption and prostate cancer risk in seven case-control studies using both crude and adjusted data (RR 1.20, 95% CI 1.02-1.40; and RR 1.21, 95% CI 1.03-1.43, respectively), whereas there was no significant association in four cohort studies using crude or adjusted data (RR 0.97, 95% CI 0.68-1.38; and RR 1.06, 95% CI 0.83-1.35, respectively). CONCLUSION: Given that a cohort study gives a higher level of evidence than a case-control study, there is no evidence to support a harmful effect of coffee consumption on prostate cancer risk. Further prospective cohort studies are required.

[The effect of smoking status upon occurrence of impaired fasting glucose or type 2 diabetes in Korean men].

OBJECTIVES: To investigate whether smoking and the smoking status are predictors of the incident impaired fasting glucose (IFG) or type 2 diabetes in Korean men. METHODS: A cohort of 1,717 Korean men without IFG or diabetes, who underwent annual periodic health examinations for 4 years (2002-2006), were retrospectively investigated. IFG and diabetes were defined as a serum fasting glucose concentration of 100-125 mg/dL and more than 126 mg/dL, respectively. Cox's proportional hazards model was used to evaluate the association between smoking and development of IFG or type 2 diabetes. RESULTS: A total of 558 cases (32.5%) of incident IFG and 50 cases (2.9%) of diabetes occurred. After controlling for the potential predictors of diabetes, the relative risk for IFG, compared with the never smokers, was 1.02 (95% CI=0.88 to 1.19) for the ever-smokers, 0.96 (95% CI=0.79-1.16) for those who smoked 1-9 cigarettes/d, 1.15 (95% CI=1.01 to 1.30) for those who smoked 10-19 cigarettes/d, and 1.31 (95% CI=1.10 to 1.57) for those who smoked 20 or more cigarettes/d (the P value for the current smokers was only p<0.002). The respective multivariate adjusted relative risks for type 2 diabetes, compared with the never-smokers, were 1.07 (95% CI=0.64 to 1.92), 1.47 (95% CI=0.71 to 3.04), 1.84 (95% CI=0.92-3.04), and 1.87 (95% CI=1.13-3.67), respectively (the P value for the current smokers was only p=0.004). CONCLUSIONS: The smoking status and the number of cigarettes smoked daily are associated with an increased risk for developing IFG or type 2 diabetes in Korean men.

Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients--a randomised trial.

AIM: To compare the efficacy of acupuncture needling and 0.5% lidocaine injection of trigger points in myofascial pain syndrome of elderly patients. METHODS: Thirty nine participants with myofascial pain syndrome of one or both upper trapezius muscles were randomised to treatment with either acupuncture needling (n=18) or 0.5% lidocaine injection (n=21) at all the trigger points on days 0, 7 and 14, in a single-blinded study. Pain scores, range of neck movement, pressure pain intensity and depression were measured up to four weeks from the first treatment. RESULTS: Local twitch responses were elicited at least once in 94.9% of all subjects. Both groups improved, but there was no significant difference in reduction of pain in the two groups at any time point up to one month. Overall, the range of cervical movement improved in both groups, apart from extension in the acupuncture needling group. Changes in depression showed only trends. CONCLUSION: There was no significant difference between acupuncture needling and 0.5% lidocaine injection of trigger points for treating myofascial pain syndrome in elderly patients.

Korean travelers' knowledge, attitudes, and practices regarding the prevention of malaria: measures taken by travelers departing for India from Incheon International Airport.

BACKGROUND: Although many Koreans travel each year to countries where malaria is present, few data are available on the knowledge, attitudes, and practices of Koreans with regards to malaria. METHODS: The study was conducted in the departure lounge of Incheon International Airport in May 2006. A 22-item questionnaire was administered to Korean travelers whose travel destination was India. RESULTS: Of 188 respondents, 24% had sought pretravel health information. Independent predictors for seeking pretravel health information were the following: being a Korean woman, longer duration of travel, planning to travel independently or to a rural area, and perceived risk of malaria. A total of 47% of travelers answered that they had not perceived any risk of malaria, and only 7% of travelers carried malaria prophylaxis. CONCLUSIONS: There is an urgent need for increased awareness about travel-related infectious diseases (especially malaria) among Korean travelers, and they should be encouraged to seek pretravel health information.

Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients.

OBJECTIVES: To compare the efficacies of dry needling of trigger points (TrPs) with and without paraspinal needling in myofascial pain syndrome of elderly patients. DESIGN: Single-blinded, randomized controlled trial. SUBJECTS: Forty (40) subjects, between the ages of 63 and 90 with myofascial pain syndrome of the upper trapezius muscle. INTERVENTIONS: Eighteen (18) subjects were treated with dry needling of all the TrPs only and another 22 with additional paraspinal needling on days 0, 7, and 14. RESULTS: At 4-week follow-up the results were as follows: (1) TrP and paraspinal dry needling resulted in more continuous subjective pain reduction than TrP dry needling only; (2) TrP and paraspinal dry needling resulted in significant improvements on the geriatric depression scale but TrP dry needling only did not; (3) TrP and paraspinal dry needling resulted in improvements of all the cervical range of motions but TrP dry needling only did not in extensional cervical range of motion; and (4) no cases of gross hemorrhage were noted. CONCLUSIONS: TrP and paraspinal dry needling is suggested to be a better method than TrP dry needling only for treating myofascial pain syndrome in elderly patients.